Introduction

Summary

Psychological disorders remain among the most highly stigmatised conditions in medical practice. Women may suffer, knowingly or unknowingly. Perhaps this is the major reason why the 2000–2002 report of the Confidential Enquiries into Maternal Deaths uncovered the startling finding that, when all deaths up to 1 year after delivery were taken into account, psychiatric illness was not only the leading indirect cause of death but also the leading cause of maternal deaths overall.

This outcome can be the result of lack of access to appropriate services, inadequate assessment, recognition and diagnosis, ineffective treatment, inconsistent review and monitoring of the interventions that have been implemented, and poor coordination between services.

This book attempts to redress the balance. It covers the psychological conditions associated with the many phases of the woman's life span: menarche, menstrual disorders, pregnancy and menopause. In parallel, but linked with cross-referencing, it aims to outline the main psychological comorbid symptoms or syndromes with which women may present.

The highlight is on description of the nature and extent of the particular condition, detection or diagnosis, the pharmacological and psychosocial interventions available and the importance of referral to and co-working with multidisciplinary teams. Substance misuse, mood disorders, severe mental illness, eating disorders, personality problems, suicide and deliberate self-harm are considered.

We highlight the growing evidence base for treatment for psychiatric disorder. It is important to underline the rapid scientific advances in mental health in general and in relation to obstetrics and gynaecology, through an understanding of the neurosciences, linked to psychosocial influences, and to the higher priority given to mental health in the national policy agenda.